Permit CITY OF TIGARD PLUMBING PERMIT
1111 s ' COMMUNITY DEVELOPMENT ' Permit#: PLM2014-00258
Date Issued: 11/20/2014
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
VI IV,�,L —
Parcel: 2S112CB00900
Jurisdiction: Tigard
Site address: 15000 SW HALL BLVD
Project: Bonaventure of Tigard Subdivision: WILSON ACRES Lot: 8
Project Description: Site utilities for a new 3-story senior living facility.(8)catch basins,(2)manholes,710 ft of sanitary sewer,2,240 ft
of storm sewer,662 ft of water service,(2)backflow preventers,(2)interceptors/grease traps&(2)storm filters.
1/26/2015: REPRINT permit to add(6)area drains,(78)rain drain connectors and(2)storm filters. 5/13/15:
Contractor: INLAND COMPANY Owner: MWSH TIGARD LLC
PO BOX 2131 3425 BOONE RD SE
BATTLE GROUND,WA 98604 SALEM, OR 97317
PHONE: 503-883-8866 PHONE: 503-566-5715
FAX:
FEES
Quantity Description Date Amount
8 ea Catch Basin or Area Drain 10/28/2014 $150.08
Specifics: 2 ea Manholes 10/28/2014 $37.52
710 If Sewer Service 10/28/2014 $325.18
Type of Use: COM 2240 If Storm and Rain Drain 10/28/2014 $887.98
Class of Work: NEW 662 If Water Service 10/28/2014 $287.66
Type of Const: 2 ea Backflow Preventer 10/28/2014 $62.54
Occupancy Grp: 2 ea Interceptor/Grease Trap 10/28/2014 $50.04
Stories: 1 12%State Surcharge- 10/28/2014 $216.12
Plumbing
29 Misc Administration Fee 10/28/2014 $28.50
1 Plan Review 10/28/2014 $450.25
6 ea Catch Basin or Area Drain 01/26/2015 $112.56
78 ea Rain Drain Connector 01/26/2015 $1,463.28
50 Misc Other Fee 01/26/2015 $50.04
0 12%State Surcharge- 01/26/2015 $195.11
Plumbing
0 Plan Review 01/26/2015 $406.47
Total $4,768.33
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ..••10.1111.11 Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
PLUMBING PERMIT
CITY OF TIGARD t
• - .• COMMUNITY DEVELOPMENT 2 Permit#: PLM2014-00258
Date Issued: 11/20/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 20/201 0900
Jurisdiction: Tigard
Site address: 15000 SW HALL BLVD
Project: Bonaventure of Tigard Subdivision: WILSON ACRES Lot: 8
Project Description: Site utilities for a new 3-story senior living facility.(8)catch basins,(2)manholes,710 ft of sanitary sewer,2,240 ft
of storm sewer,662 ft of water service,(2)backflow preventers,(2)interceptors/grease traps&(2)storm filters.
1/26/2015: REPRINT permit to add(6)area drains,(78)rain drain connectors and(2)storm filters.
Contractor: JET INDUSTRIES INC Owner: MWSH TIGARD LLC
1935 SILVERTON RD NE 3425 BOONE RD SE
SALEM, OR 97303 SALEM, OR 97317
PHONE: 503-566-5715
HONE: 503-363-2334
FAX: 503-363-2622
FEES
Quantity Description Date Amount
8 ea Catch Basin or Area Drain 10/28/2014 $150.08
Specifics: 2 ea Manholes 10/28/2014 $37.52
710 If Sewer Service 10/28/2014 $325.18
Type of Use: COM 2240 If Storm and Rain Drain 10/28/2014 $887.98
Class of Work: NEW 662 If Water Service 10/28/2014 $287.66
Type of Const: 2 ea Backflow Preventer 10/28/2014 $62.54
Occupancy Grp: 2 ea Interceptor/Grease Trap 10/28/2014 $50.04
Stories: 1 12%State Surcharge- 10/28/2014 $216.12
Plumbing
29 Misc Administration Fee 10/28/2014 $28.50
1 Plan Review 10/28/2014 $450.25
6 ea Catch Basin or Area Drain 01/26/2015 $112.56
78 ea Rain Drain Connector 01/26/2015 $1,463.28
50 Misc Other Fee 01/26/2015 $50.04
406 Plan Review-Plumbing 01/26/2015 $406.47
195 12%State Surcharge- 01/26/2015 $195.11
Plumbing
Total $4,723.33
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit ApplicatioiE"EIVE'
Building Fixtures JAN 2 6 2015 FOR OFFICE USE ONLI
City of Tigard Received {r. kV"' " �/Q 0/r_00��
Date/By: /X2 L"`� Permit No.
• 13125 SW Hall Blvd.,Tigard,OR 9 Y U� 116A10) Plan Review
■ Phone: 503.718.2439 Fax: 503.5 Other Permit No.:
DIVISION Date/By:
Inspection Line: 5013.639.4175 iN >r G D T l G A K D Date Read /B y ® See Page e 2 for
Internet: www.ti ardor. ov Notfed/Method: Supplemental Information
ormation
TYPE OF WORK FEE* SCHEDULE
ew construction 0 Demolition For s ecial in ormation use checklist
Descri.tion ME Ea. Total
Addition/alteration/replacement D Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
.." CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling mmercia1industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin area dram
/_ 18.76
l off,54 Job site address: !, Q d �� 9 G
City/State/ZIP: Drywell,leac me,or Vends drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: .64ep �y,�
/(/r7 ♦E/iTfiC/Q.,e5 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector /21 18.76 /1/4 3.;?k
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: f Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
_ Clothes washer 25.02
d �e /S 7 7NG. ,.0 C / . Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: - - .
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: Sf, .✓ L A . 25.02 _• t /
City/State/ZIP: Subtotal /;a ,9?
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) 4 6•y
State surcharge(12%of permit fee) /7 .//
Authorized signature: TOTAL PERMIT FEE 0 ,2 oz y/
Print name: Date: /-Z l ,^ / This permit application expires if a permit is not obtained within 180 days !�
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:iBuilding\Pennits\PLMl1-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-Pi 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' _ 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15000 SW HALL BLVD, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2014-00258
Inspection Type: Inspector:
340 Storm drain George Heimos
Result:
FAIL
Comments:
1 . The following existing corrections have not been completed and need to be
co pleted ASAP.
ce area drains (1-8-15),
ga rain drain risers, (downspouts), (1-8-15 and 1-20-15),
2-ea Storm filters (1-8-15).
2. Provide listings and installation instructions for both grease interceptors. (12-17-14)
3. Provide cleanouts on both grease interceptors outlet piping. Do not cover. (12-17-14)
4. Provide tests on both grease interceptors. Do not cover. (Recall inspection when
corrections have been completed. Re-inspection required. 103.5.6.11-7-15)
NOTE. Re-inspected all storm piping from storm filter (south), West and then North and
three catch basins. Original piping was installed at wrong elevation and had to be
removed and re-installed.
Violation Summary:
Inspector Contractor
,14 CITY OF TIGARD PLUMBING PERMIT
11 COMMUNITY DEVELOPMENT Permit#: PLM2014-00258
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/20/2014
Parcel: 2S112CB00900
Jurisdiction: Tigard
Site address: 15000 SW HALL BLVD
Project: Bonaventure of Tigard Subdivision: WILSON ACRES Lot: 8
Project Description: Site utilities for a new 3-story senior living facility.(8)catch basins,(2)manholes,710 ft of sanitary sewer,2,240 ft
of storm sewer,662 ft of water service,(2)backflow preventers,(2)interceptors/grease traps&(2)storm filters.
Contractor: JET INDUSTRIES INC Owner: MWSH TIGARD LLC
1935 SILVERTON RD NE 3425 BOONE RD SE
SALEM, OR 97303 SALEM,OR 97317
PHONE: 503-566-5715
HONE: 503-363-2334
FAX: 503-363-2622
FEES
Quantity Description Date Amount
8 ea Catch Basin or Area Drain 10/28/2014 $150.08
Specifics: 2 ea Manholes 10/28/2014 $37.52
710 If Sewer Service 10/28/2014 $325.18
Type of Use: COM 2240 If Storm and Rain Drain 10/28/2014 $887.98
Class of Work: NEW 682 If Water Service 10/28/2014 $287.66
Type of Const: 2 ea Backflow Preventer 10/28/2014 $62.54
Occupancy Grp: 2 ea Interceptor/Grease Trap 10/28/2014 $50.04
Stories: 1 12%State Surcharge- 10/28/2014 $216.12
Plumbing
29 Misc Administration Fee 10/28/2014 $28.50
1 Plan Review 10/28/2014 $450.25
Total $2,495.87
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct•u- • • OUNC by calling 503.232.1987 or 1.800.332.2344.
Is_ued By: • / / Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbin2 Permit AtmlicatipctINE1)
Site Utilities t' ID 1.1)11 ()pi:1(7E I-sE ONLV
City of Tigard Received 4,,
• 13125 SW Hall Blvd. Tigard,OR 97 4V ri 4 ZW4 Nidav: •
Plan Review /J.( ioy. Pcrmit No.: .., ,..;. _•0,26-7r
PI 1 ' Phone: 503 718.2439 Fax. 503.590 Date/B : 1 • .....Mli Other Penni{No.: 6 • A • l5 7
Inspection Line: 503.639.4175 E.T 1 6 Niko Date Readylay: II See . 2k,
TIGARD
Internet: www.tigard-orgov 'ITV OR' I' . Notified/Method: 4 / Li / 10 Supplententslinformation
•
44-.;:11J!-,P71.--;!.'n. . !iii;i4F*-) ": .. gri‘VOIA7:`,'QT.:,. .. ,. . ,.. n ...,•:---!11
..latrw construction 0 Demolition t_.i For special information ate checklist.
Description I Qty. I Ea I Total
0 Addition/alteration/replacement 0 Other. New 1-2-fa mlly dwellings(includes 100 ft.for each utility connection)
F"-IT.n ■V 0;itdijl*.gfilit-00Wikii i".:::!,:: :. ; i;.:i],-.: SFR(1)bath 312 70
437 78
0 1-and 2-family dwelling . Commercial/industrial SFR(2)bath
SFR(3)bath 500.32
C)Accessory building alAulti-family
Each additional bath/kitchen 25.02
ID Master builder 0 Other:
Fire sprinkler( .sq.ft.) Page 2
-I0.1471,1-21.,,VitiglOgilliFtriMAIYION,':Arin.:LocATioN: ::,T:::: ::;i:,T'rl,;n:1,,- Site utilities:
Job site address:
Catch basin or area drain (9) 18.76
i 5-0 0 el A-1-11-•LC__
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 11 c o.A... C1 i Ore- 11 2-33
Footing drain(no.linear ft.:...,_) Page 2
Suite/bldg./apt,no.: u 1
Project name: eurv",evittArt• oe T13et,/ Manufactured home utilities 50.03
Cross strectMirections to job site:
' Manholes 'i--- 18.76
, IV ')‘le Rain drain connector 18.76
Sanitary sewer(no.linear filEZ) ' Page 2
,.. \ ._...f4
Storm sewer(no linear ft.:tzID Page 2
. 1 1 .
.• i .- Water service(no.linear It.:tig3.-- Page 2
Subdivision: CO:Zie," Lot no.:i.c.it00° Fixture or item:
Tax map/parcel no.: 2.5-1 teL c.6 46 a 9 c9 0 Backflow preventer 02 31.27
--, •. .(4i-,,:.-,....„i.,,,,., Backwater valve 1:.:a..-t.wi.4ii-+. * j,o,q 0- it.;*, ;-R,i••ti-,..::.-,-!:j'V-',i,t p-r O-lii-IM.0FF.,,•1:.4.-;-.'•.
Clothes washer 2125..052 1
ew (k )4 i ,)te V i i( ./I
Dishwasher 25.02
5 S f-0-01^4-i 45 eg"- e'N---' 1 k U k ) Drinking fountain . 25.02
1 Ejectors/sump
1 , l'Irtli" 2.5 02
, .
t'i.;.;:. ,:4•k::'.i.E0,..00.y.ctt.'pviypt,,;'i,-.7,S.44,1ag.,:[altatif,k4ftettip Expansion tank I`..,i'-', (it 0 '• v 12.51
Name: taps"am..reinkt.A‹ erc-rtscpLce, j„..,(,C Fixture/sewer cap ... -1,/44 _ter 25.02
Floor drain/floor sMk/hub 25.02
Address: $t12.S- g OCite.-4. Qp,
Garbage disposal 25.02
City/State/ZIP: S a(.6,..... dia_ 913 11 Hose bib 25.02
Phone:( co$ 5-(pco• 57)5--- Fax:( -9-- Ice maker 1231
10.1-400404";2. :.-.i.V2.■ -rli:.,"ff!.,'Ith-2;001.1.0.$0.111-g::"4'.. Interceptor/grease trap 1.- 25.02
Business name: Ilt,teua..t.•4 LA'ct./14 ,f...An.c(-.%. CA 11;.-e..1_ Medical gas(value:$ ) Page 2
Printer 12 51
Contact name: J t vii-... M.o.riks,.......
Roof drain(commercial) 12.51
Address: /$-00. ' 3462.c ecno/V"-E. 141 Sink/basin/lavatory 25.02
City/State/ZIP: - ;.uffi c,..te",4 the .:t 7 3 t 7 Solar units(potable water) 62.54
Phone:( 57))3 3/3...s ic„r I Fax::( ) Tub/shower/shower pan 12.51
E-mail: jctark.c.....e if 4. e c L.-- Ceno---- Urinal 25.02
. ,. , .r, .. ..,., , , Water closet 25.02
g'•er* q:Pi.qt1:1-64-41-i.51'g.. ii.`"‘;'.....-41:-e
- Water heater 37.52
Business name: --S -r- i iN„Y• uc.,T.ak ....) I NY,- - Water piping/DWV ilo es.,Aaw 56.29
Address: 1 5- lc Jikr-77A) --k0 x)L. Other:5 r,„1..., )11...te,:--r--- -7--- 25.02
i
City/State/ZIP: Se4-L.V.-/ C 0.._ (7 7 30-"?.? Subtotal
Phone:(SZ.);$ .3,6,3--. 3.3 ' Fax:( ) Minimum pemrit fee: $72.50
CCB Lie.: 39 Plumbing Lic no.: Plan review (25%of pemin fee)
, e1-114pf)
State surcharge(12%of permit fee) 4 -
Authorized signaluns: 5-4L--
TOTAL PERMIT FEE
■
This permit application expires if s penult is not obtained within ISO days
Print name: Crt.,, (2.0..).X I Date: •-•.;j rii ty
after it has been accepted as co evict c.
'Fee methodology set by Tri-Couaty Building Industry Service Board.
r\Buil&nglPecraits\PL.MIJ.Psnratlpp doc
10/01/09 440-4616T(I 0/02/COMAYEB)
' >r
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
III • r Transmittal Letter
r 1,„A li I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: C5 fle, ,n,_,9 DATE RECEIVED:
DEPT: BUILDING DIVISION ,.1
____... ,
FROM: \�� .r-.NN-5,., a(� SEP 1 u 4014
�l tC� w CITY OF TIGARD
COMPANY: j �G PLANNING/ENGINEER1Nr"
PHONE: '3 —6 gb —66L�'�T› o`�j By:,2
RE: 1 G LjI--- 144 15)11,04 PG/)120;ii-- C)&125 7
(Site Address) (Permit Number)
( ja(`name or elvisi o�. / . /
ProJ�ct name or su divisiofitutafame and;o umber}
ATTACHED ARE THE FOLLOWING ITEMS:
Co ies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: \--__,,e1.10-, .\ C -CI
;' 2� Lcs
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Description: Amount Due:
$
. $
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑No ❑ Done
Applicant Notified: Date: Initials:
1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
- , r
CE S NW
RECEIVED
SEP 17 2014 LETTER OF TRANSMITTAL
TO: �v. / N ,, �, 1' 1 DATE ///4//� JOB#: ��
SUBJECT: -'✓z 74
ATTENTION: (U/ L
WE ARE SENDING YOU:
Prints ❑ Plans ❑Specifications ❑Copy of letter
Documents ❑ Reports ❑Change order ❑Samples
❑ Other:
COPIES D. If NO. DESCRIPTION
i‘ ,- fir:J . p
THESE ARE TR.ANSMTITED AS CHECKED BELOW:
For approval ['For your use ❑As requested ❑ For review and comment
❑Other.
['FOR BIDS DUE:
REMARKS:
COPY TO: SIGN :.JjJ,
-- ---- 1,
CESNW, INC.
13190 SW 68TH PARKWAY,STE.150,TIGARD,OR 97223
503.968.6655 T 503.968.2595 F WWW.CESNW.COM
/5-000 sic/ NA L L- &L✓D
pt.kvi jolt'— oo2.5-�
PWS ID# 4 1 _ MICROBIOLOGICAL ANALYSIS Sample#: Paid:
Name of Water Systetd: �/fit, df 72i7.1.0-1 Alexin Analytical Laboratories 5 1 0 5 '�
13035 SW Pacific Hwy,Tigard,OR 97223 Date/Time R ceived: Received by:
Phone: 6%5'gf L`c!'1Co Fax: 503-639-9311 OR 100013 i J `;"/is- /431 tr
LABORATORY RESULTS Dat /Time//Analysis Start. Analyzed by:
Collection date/time: I/ 34/ /S _a.m./p.m. r t I �J (�, J 5
Total Coliform: E.coli/fecal 1
Collected by: Y t� (1. Date/Time Analysis Complete: Completed by:
Sample type: ,X- special other n Absent Absent
Sample point: 151PK1 Olf( OW 5I�- t�w1s5 ST I S i 1 1 3 '. (� J S
p p Present Present Comments:
Chlorinated?: no _Xes Free Chlorine • I ?mg/L SPC: CFU/mL •'rim
sample temperature /,---,?, 2.°Cllr
g Test Methods:(check all that apply) L
. City of Tigard \/
- CSM 9223 Colilert �Colilert-I8 Reported b Y
p y 1
x:
i 13125 SW Hall Blvd
Colisure _Quanti-tray SM ed al date:Z f L J 1
_
j f Tigard, OR 97223 c 3d) SM 9221E
Reviewed by J7.'"...—
.w,.cnu.,a a.,.,t,.,...... —r.„„.........„..ample only as submitted,and may not be indicative of the ,.1
results of previous or subsequent testing of this water supply. The laboratory certifies that the test results meet date: — '<.( 'vs
all the requirements of NELAC.
70 LI►a V Ei-1 1-'t.-0.,E. -- a 4 S S T k /44 LC 61- . D nn 4.y T►c..
LAJi r 1 f.,2. ,,,,e t si9A ss�.cj